Difference between revisions of "Lung cancer staging"
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The article deals with '''lung cancer staging'''. A general discussion | The article deals with '''lung cancer staging'''. A general discussion about staging is found in ''[[cancer staging]]''. | ||
==General== | ==General== | ||
| Line 7: | Line 7: | ||
===Tumour=== | ===Tumour=== | ||
AJCC 7th edition:<ref>{{Ref AJCC7HB|316}}</ref> | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
!T stage | !T stage | ||
| Line 25: | Line 26: | ||
| T1a | | T1a | ||
| <=2 cm | | <=2 cm | ||
| confined to lung, no [[VPI]], no main branch bronchus involvement | | confined to lung, no [[visceral pleural invasion|visceral pleural invasion (VPI)]], no main branch bronchus involvement | ||
| | | | ||
|- | |- | ||
| Line 39: | Line 40: | ||
|- | |- | ||
| T2b | | T2b | ||
| >5cm | | >5cm, < 7cm | ||
| confined to lung, no total lung collapse | | confined to lung, no total lung collapse | ||
| | | may have VPI ''and/or'' main branch bronchus involvement | ||
|- | |- | ||
| T3 | | T3 | ||
| >7 cm ''or'' | | >7 cm ''or'' total lung collapse ''or'' presence of two or more tumour nodules in same lobe ''or'' minor extension beyond lung | ||
| | | ''minor extension beyond lung'' includes any of the following: parietal plural of chest wall or mediastinal pleura, diaphragm, phrenic nerve, parietal pericardium | ||
| | | ipsilateral tumour nodule(s) in a ''different'' lobe is T4 | ||
|- | |- | ||
| T4 | | T4 | ||
| extension beyond the lung | | major extension beyond the lung ''or'' separate lesions in others lobes on the ipsilateral side | ||
| | | ''major extension beyond the lung'' includes any of the following: carina, trachea, esophagus, recurrent laryngeal nerve, mediastinum, heart, great vessels, vertebral body | ||
| | | separate lesions on the contralateral side are M1a<ref>{{Ref AJCC7HB|317}}</ref> | ||
|} | |} | ||
===Lymph nodes=== | ===Lymph nodes=== | ||
AJCC 7th edition: | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
!N stage | !N stage | ||
| Line 142: | Line 144: | ||
Note: | Note: | ||
*‡ Contralateral lymph node involvement is ''N3''.<ref name=pmid24624287>{{Cite journal | last1 = Terán | first1 = MD. | last2 = Brock | first2 = MV. | title = Staging lymph node metastases from lung cancer in the mediastinum. | journal = J Thorac Dis | volume = 6 | issue = 3 | pages = 230-6 | month = Mar | year = 2014 | doi = 10.3978/j.issn.2072-1439.2013.12.18 | PMID = 24624287 }}</ref> | *‡ Contralateral lymph node involvement is ''N3''.<ref name=pmid24624287>{{Cite journal | last1 = Terán | first1 = MD. | last2 = Brock | first2 = MV. | title = Staging lymph node metastases from lung cancer in the mediastinum. | journal = J Thorac Dis | volume = 6 | issue = 3 | pages = 230-6 | month = Mar | year = 2014 | doi = 10.3978/j.issn.2072-1439.2013.12.18 | PMID = 24624287 }}</ref> | ||
===Metastases=== | |||
AJCC 7th edition: | |||
{| class="wikitable sortable" | |||
!M stage | |||
!Criteria | |||
!Comment | |||
|- | |||
| M1a | |||
| nodule in contralateral lung ''or'' malignant pleural effusion ''or'' malignant pericardial effusion | |||
| malignant effusion in a previous edition were pT4<ref>{{Ref AJCC7HB|299}}</ref> | |||
|- | |||
| M1b | |||
| distant metastasis (extrathoracic organs) | |||
| | |||
|} | |||
==See also== | ==See also== | ||
*[[Lung tumours]]. | *[[Lung tumours]]. | ||
*[[Lung adenocarcinoma]]. | |||
*[[Lung squamous cell carcinoma]]. | |||
==References== | ==References== | ||
Revision as of 16:20, 10 April 2017
The article deals with lung cancer staging. A general discussion about staging is found in cancer staging.
General
The clinical staging and pathologic staging are concordant in only approximately ~50% of cases.[1]
TNM staging system
Tumour
AJCC 7th edition:[2]
| T stage | Size/criteria | Other requirements | Comment |
|---|---|---|---|
| T0 | (no tumour) | rare | |
| Tis | no invasion | rare | |
| T1a | <=2 cm | confined to lung, no visceral pleural invasion (VPI), no main branch bronchus involvement | |
| T1b | >2 cm, <=3 cm | confined to lung, no VPI, no main branch bronchus involvement | |
| T2a | >3cm or VPI or main branch bronchus involvement, <= 5cm | confined to lung, no total lung collapse | |
| T2b | >5cm, < 7cm | confined to lung, no total lung collapse | may have VPI and/or main branch bronchus involvement |
| T3 | >7 cm or total lung collapse or presence of two or more tumour nodules in same lobe or minor extension beyond lung | minor extension beyond lung includes any of the following: parietal plural of chest wall or mediastinal pleura, diaphragm, phrenic nerve, parietal pericardium | ipsilateral tumour nodule(s) in a different lobe is T4 |
| T4 | major extension beyond the lung or separate lesions in others lobes on the ipsilateral side | major extension beyond the lung includes any of the following: carina, trachea, esophagus, recurrent laryngeal nerve, mediastinum, heart, great vessels, vertebral body | separate lesions on the contralateral side are M1a[3] |
Lymph nodes
AJCC 7th edition:
| N stage | Criteria | Comment |
|---|---|---|
| N0 | no lymph node metastases | |
| N1 | metastasis in any ipsilateral node | includes hilar, peribronchial & intrapulmonary nodes; direct extension also counts |
| N2 | metastasis in any ipsilateral mediastinal node or subcarinal node | |
| N3 | metastasis in any contralateral node, scalene node or supraclavicular node |
Lymph nodes stations
| Station number | Location | N Staging ‡ |
|---|---|---|
| Station 1 | lower cervical, supraclavicular, sternal notch | N3 for supraclavicular,[4] N2 for others |
| Station 2 | upper paratracheal nodes (left and right) | N2 |
| Station 3 | prevascular (anterior) and retrotracheal (posterior) | N2 |
| Station 4 | lower paratracheal (right and left) | N2 |
| Station 5 | subaortic/aorto-pulmonary window | N2 |
| Station 6 | para-aortic (phrenic or asc. aorta) | N2 |
| Station 7 | subcarinal | N2 |
| Station 8 | paraesophageal | N2 |
| Station 9 | pulmonary ligament | N2 |
| Station 10 | hilar nodes (left and right) | N1 |
| Station 11 | interlobar nodes (left and right) | N1 |
| Station 12 | lobar (left and right) | N1 |
| Station 13 | segmental (left and right) | N1 |
| Station 14 | subsegmental (left and right) | N1 |
Note:
- ‡ Contralateral lymph node involvement is N3.[5]
Metastases
AJCC 7th edition:
| M stage | Criteria | Comment |
|---|---|---|
| M1a | nodule in contralateral lung or malignant pleural effusion or malignant pericardial effusion | malignant effusion in a previous edition were pT4[6] |
| M1b | distant metastasis (extrathoracic organs) |
See also
References
- ↑ López-Encuentra, A.; García-Luján, R.; Rivas, JJ.; Rodríguez-Rodríguez, J.; Torres-Lanza, J.; Varela-Simo, G. (Mar 2005). "Comparison between clinical and pathologic staging in 2,994 cases of lung cancer.". Ann Thorac Surg 79 (3): 974-9; discussion 979. doi:10.1016/j.athoracsur.2004.06.004. PMID 15734416.
- ↑ American Joint Committee on Cancer (2010). AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual (7th ed.). New York: Springer. pp. 316. ISBN 978-0387884424.
- ↑ American Joint Committee on Cancer (2010). AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual (7th ed.). New York: Springer. pp. 317. ISBN 978-0387884424.
- ↑ Riquet, M.; Mordant, P.; Fabre-Guillevin, E.; Arame, A.; Foucault, C.; Dujon, A.; Le Pimpec Barthes, F. (Dec 2013). "Long-term survival with surgery as part of a multimodality approach for N3 lung cancer.". Eur J Cardiothorac Surg 44 (6): 1117-22. doi:10.1093/ejcts/ezt171. PMID 23543202.
- ↑ Terán, MD.; Brock, MV. (Mar 2014). "Staging lymph node metastases from lung cancer in the mediastinum.". J Thorac Dis 6 (3): 230-6. doi:10.3978/j.issn.2072-1439.2013.12.18. PMID 24624287.
- ↑ American Joint Committee on Cancer (2010). AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual (7th ed.). New York: Springer. pp. 299. ISBN 978-0387884424.